Propensity score-matched analysis of systemic chemotherapy versus salvage hysterectomy for persistent cervical cancer after definitive radiotherapy/concurrent chemoradiotherapy

Munetaka Takekuma, Fumiaki Takahashi, Seiji Mabuchi, Wataru Kudaka, Koji Horie, Mariko Ikeda, Ayumi Shikama, Akira Mitsuhashi, Shoji Nagao, Shiro Suzuki, Mika Mizuno, Shin Nishio, Hideki Tokunaga, Yukinobu Ota, Takahiro Kasamatsu, Ryo Kitagawa, Takafumi Toita, Hiroaki Kobayashi, Mitsuya Ishikawa, Nobuo Yaegashi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The aim of the current study was to evaluate oncologic outcomes of patients who were treated with salvage hysterectomy (HT), compared to systemic chemotherapy (CT) for persistent cervical cancer after definitive radiotherapy (RT)/ concurrent chemoradiotherapy (CCRT). Methods: Patients with persistent cervical cancer treated with definitive RT/CCRT at 35 institutions from 2005 to 2014 were reviewed retrospectively (n = 317). Those who underwent a HT for persistent cervical cancer after definitive RT/CCRT were matched with propensity scores for patients who underwent systemic CT. Oncologic outcomes between the two groups using a propensity score matched–cohort analysis were compared. Results: A total of 142 patients with persistent cervical cancer after definitive RT/CCRT were included after matching (HT: 71, systemic CT: 71). All background factors between HT and CT groups were well balanced. Median overall survival was 3.8 and 1.5 years in the HT and CT groups, respectively (p = 0.00193, hazards ratio [HR] 0.41, 95% confidence interval [CI] 0.23–0.73), Increasing residual tumor size was significantly associated with a high incomplete resection rate (p = 0.016, Odds Ratio 1.11, 95%CI 1.02–1.22). Severe late adverse events occurred in 7 patients (9.9%) in the HT cohort. Conclusion: The current study demonstrated that, when compared to systemic CT, the adoption of salvage HT for patients with persistent cervical cancer after definitive RT/CCRT reduced mortality rate by about 60%. This indicates that salvage HT could be curative treatment for those patients. Further prospective clinical trials with regard to salvage HT after RT/CCRT are warranted.

Original languageEnglish
Article number1169
JournalBMC Cancer
Volume20
Issue number1
DOIs
Publication statusPublished - 2020 Dec

Keywords

  • Persistent diseases
  • Radiotherapy
  • Salvage hysterectomy
  • Survival
  • Uterine cervical Cancer

ASJC Scopus subject areas

  • Genetics
  • Oncology
  • Cancer Research

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